WEEKEND COLUMNISTS We are living in uncertain times. Circumstances will probably have changed by the time this column appears, but whatever happens, swine flu will probably still be making headlines.
People don’t like uncertainty, either as patients or doctors. It would be easier if we could predict the spread of disease reliably, or the effect of medications accurately. The prospect of a swine flu pandemic has triggered a million questions and concerns – and the answers to a substantial proportion of them remain unclear.
This is not stopping many people from trying to make a fast buck. Companies are selling alternative and complementary medicines – which will, so they say, reduce the chances of flu – and expensive hand washes, insisting they are essential in pandemics. These products parade all manner of claims, yet few admit they are untested. Conversely, people who are honest about the uncertainty of the evolving flu situation have been misquoted or have had their estimates pushed to the edges of reason by an anxious media.
And then there are face masks. Newspapers seem to love the sight of people in face masks, an outward sign of inner fear and supposed global hysteria. But is there evidence for using them at all? Even in straightforward operations, there is reasonable doubt about whether surgical face masks can help to reduce infection. A systematic review from 2005 says: “It is unclear whether wearing surgical face masks results in any harm or benefit to the patient.”
So what about using masks to prevent flu? A paper published this year in Emerging Infectious Diseases examined the effectiveness of masks in common or garden flu, and concluded that “household use of face masks is associated with low adherence and is ineffective for controlling seasonal respiratory disease”. Face masks worn by the healthy in an attempt to protect themselves against flu are not recommended by the Health Protection Agency because “the available evidence does not suggest that this is an effective preventative measure”.
The HPA also rightly points out that there may be problems associated with healthy people wearing face masks “just in case”. People with flu infections might go out wearing them rather than staying home. It may also give a false sense of security and discourage people from doing things that have ample evidence to support them: simple, basic things such as washing your hands with soap regularly.
The irony is that while we fret in the west over swine flu, the brunt of suffering is likely to be borne in the developing world. Here, we have clean water and sanitation, making flu hygiene easy. A global epidemic may sadly illustrate how marked global health inequalities are.
Margaret McCartney is a GP in Glasgow
For lively discussion of the latest medical issues go to Margaret McCartney’s blog at blogs.ft.com/mccartney
